PurposeTo assess the effectiveness of transarterial bland embolization (TAE) compared with transarterial chemoembolisation (TACE) therapy in the treatment of patients with intermediate-stage hepatocellular carcinoma (HCC). Methods2,297 patients with intermediate-stage HCC were screened, and 1,461 patients who received TAE or TACE as the first-choice treatment were retrospectively analyzed and baseline matched according to the two treatment methods. Subgroup analysis was performed among patients according to the "Up-to-Seven" criteria. The primary endpoint was overall survival (OS). ResultsA total of 1461 patients with HCC receiving TAE or TACE were included; 730 patients received TACE, and 731 received TAE. The patients in the TAE group exhibited poorer liver function and a significantly higher rate of hepatitis B infection (P<0.001) compared to the TACE group. After PSM, 504 well-matched pairs of intermediate-stage patients were selected for analysis. Univariate analysis showed TACE significantly prolonged patient survival compared with TAE (P<0.001). The 1, 2, and 3-year OS rates for the TACE group were 74.3%, 57.1%, and 44.4% and rates for the TAE group were 58.3%, 32.4%, and 21.7%. Multivariate analysis showed a HR of 0.517 (95% CI, 0.442-0.605, P<0.001) for the TACE approach over the TAE approach for OS. The TACE group had a significantly higher overall response rate than the TAE group (35% versus 26%, P = 0.024). ConclusionTACE resulted in higher response rate and longer overall survival compared to TAE as the initial treatment for intermediate-stage HCC.